In Case Of Misdiagnosis
by KartheyM
Summary: A girl walks into Clinica Sanando with a mysterious problem. Dr. Holt thinks he knows how to help her; but what if it's a case of misdiagnosis? *PLEASE Read & REVIEW! :)*
1. Chapter 1: The Patient

_*Author's note: Yes, I realize that the character in this episode is named Karthey. I did it on purpose.-KM  
_

Kate Sykora ran a hand over her forehead as she dismissed the day's first patient with a smile. Clinica Sanando certainly kept things interesting at a mile-a-minute! Yet the breakneck pace the walk-in clinic functioned at was exactly Kate's style. She thrived in being able to dash back and forth from lobby to exam room and back again, knowing that each time, a person could walk out feeling better than they had in a while.

Zeke Barnes, her coworker, joined her at the front of the lobby as Kate found herself immobilized by the sight of all the people still waiting—and it was only eight in the morning!

"Where do they all come from, do you think?" he murmured in her ear with his usual cynical grin.

Kate found Zeke's typically morose demeanor invigorating. It challenged her to keep a positive outlook, and never failed to make her feel better when she could.

"I dunno, Zeke," she returned with a grin, "I'll bet they ship them here from every hospital on the eastern seaboard, just for us!"

Zeke smirked and grabbed the next two patient files. He handed one to Kate after peeking at the information, "Oh, look, this one's from way out on the coast of 'Just Down The Street.'" He shook his head and stepped toward the waiting room. "Enjoy your out-of-state visitor!"

Kate peeked at the name, and stepped forward to call it, "Uh, Karthey Devanne?"

"She's over here," a grey-haired woman raised her hand. Next to her crouched a young woman who had one arm over her stomach and one hand on her head. Kate wove her way through the crowd to get to the woman.

"Can she walk?" Kate asked.

Mrs. Devanne nodded. Karthey looked up, her face twisted into a grimace. "My head hurts, and I feel really sick," she moaned.

Kate gently guided Karthey to her feet by her shoulder, "Okay, let's get you into an exam room." She looked up at Autumn, who was still accepting forms from patients walking in and answering the phone as it rang. "Autumn, do I have a room?"

Autumn glanced down at a stack of paper. "Number Two is open," she said.

"Okay, thanks."

Just outside the exam room, Autumn grabbed Kate's arm, "Oh, Dr. Kate, about that one—" she let her voice trail confidentially, and Kate allowed Mrs. Devanne to help Karthey into the room and close the door.

"What is it?" Kate asked.

Autumn flipped open the file in Kate's hand to the medical history form. Kate saw current information, such as date of birth, address, nature of problems—but a lot of the medical history was left blank. She frowned; what sort of person wouldn't know basic medical information, both family-related and personal?

Autumn shrugged, "I tried to tell her that we needed more information, but she kept trying to tell me that's all she knew. The mom has Medicaid, but that's all I can find. There's no dad," Autumn glanced at the door, "and how can someone so old have a girl so young?"

Kate shook her head at the receptionist, "You've been here for a long time, Autumn," she remarked, opening the door, "you should know when not to judge."

Autumn rolled her eyes and returned her duties at the desk.

Kate meanwhile, now found herself in the position of having to confront the mother and daughter about the mystery, and she did so head-on.

"So, Karthey," she looked down at the file, "You say you've been having headaches," she flipped the form around to show the girl, who by now had both hands wrapped around her head, "but my problem is those headaches could be a million things, and we need more information about your medical history to know what to rule out and what conditions to consider."

Karthey dropped her hands, but still behaved as if her head was too heavy to lift. "I'm sorry, ma'am," she said quietly, "It's like I told the lady out front, I wrote as much as I knew."

"Well, if you didn't know how to answer some questions," Kate persisted, adding _most of which are easy enough_, in her head, "why couldn't you ask your mom?" She pointed to Mrs. Devanne.

Karthey massaged her temples and finally looked up at Kate. "That's not my mom," she admitted, "Martha's my guardian. I'm a foster kid." Karthey grimaced again. "Please!" she begged, "I've had the worst headache of my entire life for almost two weeks now, and I've tried every kind of pain reliever I could get: Advil, Tylenol, Excedrin—nothing works! Can you help me?"

Kate balked, but the more she watched the pair, the more that stubborn streak inside her wanted to say "Heck!" to the rules and help her anyway, regardless of the risk. At the very least she could get the girl a more effective analgesic!

Kate nodded at Karthey, "Okay, I can help you." She went to the linen cupboard and pulled out a fresh gown. "Go ahead and take your shirt off and put this on while I get an IV ready for you," she instructed, "I'll be right back."

Kate left the two women in the room and went down the hall to the storage room. She grabbed some saline solution and Toridol.

When she returned to the exam room, Karthey was dressed in the gown she had given her, while Mrs. Devanne folded Karthey's clothes neatly on her lap.

Kate showed them the medication, "Okay, this is just a generic painkiller called Toridol, sort of like liquid Tylenol, but the IV will get it straight to your system, so it should be a lot more effective than oral medication."

She turned to Karthey, "Let's get you hooked up. Are you allergic to iodine?"

Karthey held out her right arm as Kate beckoned for it. "I don't know; I don't think so."

"She had a nasty cut once," Mrs. Devanne offered, "and I cleaned it with iodine and Karthey didn't have a problem."

Kate nodded, "Okay, sounds good." she brushed the inside of Karthey's elbow with the bright-orange ointment and, to draw her attention away from the needle, she asked, "So how did you two end up together? Did Martha know your birth mother?"

Karthey shook her head, deliberately avoiding the sight of her arm as Kate inserted the IV needle. "Nobody knew who my mom was. Martha says she was a Jane Doe."

Mrs. Devanne spoke up, "I had wanted to be a foster mother ever since my husband died. Our five children were all grown and had families of their own. I guess I was a bit of an empty-nester, you might say. I knew a lot of the staffers at a local foster agency here in New York, so once I knew I would be alone at the house I just sent them word that I was open to any child for which they could not find a suitable home, if they deemed I was then suitable for the child." the elderly woman sighed and tucked a loose wisp of hair behind her ear. "A few lonely kids found their homes under my roof until circumstances changed and a better fit was found elsewhere." she chuckled, "I could give kids a good home, but I couldn't quite give them _everything_, if you know what I mean, Dr. Sykora."

Kate nodded; if the woman qualified for Medicaid, it was a wonder she thought she had enough to give kids that weren't even hers. It certainly spoke volumes to the young physician of the older woman's compassionate heart.

Martha smiled at Karthey, who had finally begun to relax as the Toridol dripped into her system and took effect. "Then one day one of the advocates called me up and said, 'Boy, Auntie Devanne, I've got a case that's right up your alley!'"

Kate smiled too, "And Karthey came to be your daughter?"

Mrs. Devanne nodded, "She was just a little thing, only two weeks old, born to a Jane Doe, they said, who had just died in the hospital before they could find out who she was. So I got Baby Doe, and I polled my kids for a name for their new sister, and one of my daughters came up with the name Karthey Anne." Mrs. Devanne came and stood by her foster daughter's side and clasped her hand. "And she's been my Karthey Anne ever since."

Kate noticed the first glimmer of a smile on Karthey's face, and she pointed to it. "Now there's something I like to see!" she cried, "Are you feeling better?"

Karthey laughed and leaned back against the pillow behind her. "Yes!" she sighed gratefully, "I think the IV worked; the pain is gone. It feels so good to be normal again, Dr. Sykora."

Kate laughed, "Okay, you guys can call me Dr. Kate. Now, Karthey, would you mind telling me how and when the headaches and nausea began?"

Karthey pursed her lips, "Well, the nausea didn't come until two days ago, but the headaches started about two weeks ago.

"I was camping with some friends, and one night I woke up with this incredible pressure in my head. I rolled over, and the pressure went away. I thought it was just because I was on a sleeping mat instead of a mattress, and that it would go away as soon as I got home." Karthey frowned, "But the pain only got worse. Two days after I got home, I could only lie on my back. Then the pressure would build up every time I lay down, so I tried sleeping propped up with pillows. Then the pressure was constant, even walking around throughout the day. I couldn't concentrate at school, I couldn't study at home, it was _so bad!_" Karthey glanced at Martha, "I literally felt like a full-grown person was sitting on my head all day long, and all night. Like I told you before, no amount of medication I tried did anything at all to ease the pain, and just yesterday morning, I woke up and the first thing I wanted to do was hurl."

"You threw up?" Kate asked.

"At first I thought she must have picked up the flu," Mrs. Devanne added, "so she stayed home from school and rested, and didn't eat. But this morning, about three A.M., I found her heaving over the toilet again, only this time she had nothing in her stomach, so it was just dry heaves. Then I knew it must be a problem that we could not handle by ourselves."

Kate frowned. The pressure in the head, and the vomiting (probably induced by the pain)—nothing sounded at all like any sort of recognizable condition. Usually, when a patient began describing symptoms, Kate was smart enough to come up with a litany of diseases by the first three, and as the patient continued, weed out the most unlikely one by one till they arrived at the right one. But Karthey's condition was beyond her; it sounded like a problem for Dr. Michael Holt. But he wasn't due for another hour, if he was in a good enough mood today to show up at all.

Karthey looked up at her, "Dr. Syk—Kate," she asked, "Do you know what might be causing the headaches?"

Kate sighed, "Well, I'm not a specialist, that's for sure," she said, "but we have a doctor who specializes in that sort of thing who volunteers here. He should be here in about an hour. He would be able to help us out." She slipped on a pair of gloves, "Maybe a closer look and a little feel around your head would give us a better idea."

Kate reached around the back of Karthey's neck, feeling her scalp carefully, "So I know you're not in pain right now," she began, "but when you do have the headaches, where is the pain?"

"All over," Karthey replied without hesitation. "It's like giant hands are squeezing all around my head."

Kate's inspection reached the area behind Karthey's ears, and she felt a large irregularity on Karthey's right side. "Karthey, what's this?" she asked the patient.

"Oh, that?" Karthey picked her head up and looked at Kate, feeling the lump for herself. "I don't really know what that is. I've had it since I was a baby. I always thought it might be a bone growth or something. Do you think that's what's causing the headaches?"

Kate glanced at Mrs. Devanne for some explanation, but the older woman shrugged, "I don't know what the lump is, either. She came that way from the hospital. They told me the baby had experienced slight head trauma at birth."

Now Kate was very confused. This was not something she was used to; it didn't feel like a bone growth at all. If Kate didn't know any better, it felt more mechanical than biological. But what on earth could it be? And how could a hospital dismiss it as "head trauma"?

"Not that it probably has anything to do with her headaches," Mrs. Devanne remarked, "but Karthey also has a two-inch scar on her chest. It was almost the length of her abdomen when she was a baby."

Kate raised her eyebrows; this was definitely unheard of: a mechanical "growth" and a two-inch scar, on a _baby_, and no one attaches any sort of significance till _now_? She turned to Karthey, "Really?" she asked.

"Yeah," Karthey gestured to her chest, just below her sternum. "It doesn't really even look like a scar. I always thought maybe my skin had developed that way."

Kate sighed; she knew that the one thing that would tell them the most about what was going on in Karthey's head would be an MRI or at the very least a CT scan, but the clinic had neither. She could keep Karthey supplied with Toridol, but if they really wanted to get to the bottom of this mystery, she could not wait for Dr. Holt to arrive.

"I'm going to go make a call, Karthey," she told her patient, "You can wait right here, I'll be back."

"Okay," the girl replied, "thanks, Dr. Kate."

Kate smiled, "No problem," she said, and left the room.


	2. Chapter 2: Action, Reaction

Zeke had just discharged a patient when Kate emerged.

"How's it going in there?" he asked her, noticing her flustered look and the cell phone in her hand.

"Pretty good," Kate sighed shortly. "Just calling our resident brain specialist right now."

"Brain specialist?" Zeke echoed with a puzzled expression, "You have a head case in there?"

Kate paused in her dialing to answer Zeke, "Headaches, a 'bone growth' behind the ear that feels like a pump or a valve of some sort, and a two-inch scar just below her sternum that she doesn't know where it came from, and a hospital that told the foster agency that all the physical defects were the result of _birth-induced trauma_." Kate's wry frown showed Zeke exactly what she thought of the story.

Zeke nodded, "Make the call, Kate."

Kate lifted the phone to her ear. A couple rings, and she heard Michael Holt's quick voice on the other end, "Hello?"

"Hi, Michael," Kate began, getting right to business, "I have a patient here complaining of headaches—"

"Oh, come on, Kate!" Michael interrupted, sounding very frazzled. "I'm not due there for another hour, I'm sure whatever it is can wait till then!"

"Well, I've just been talking with her, and I'm not so sure, Michael!" Kate returned, "She has something behind her ear that feels like a pump, but she thinks it's a bone growth. She has a two-inch suture on her chest that she's had since her _foster mother _received custody of her," Kate placed especial emphasis on the words, "and they have no idea what's causing the headaches, and frankly, I can't think of any condition that would match the symptoms she has! I really think she needs an MRI, which, as you know—"

"Yeah, the Clinic doesn't have; look, Kate, I'm in the middle of something right now. I'll be over there at ten o'clock, just like I promised. Tell you what, if you think it's something serious, why don't you try X-raying her neck, see if you can pick up this pump thing, and maybe you can get enough answers to tide you over till I get there."

"Fine," Kate sighed, "all right." She hung up the call and turned around. Zeke stood right behind her. Kate rolled her eyes, "The best we can do to get eyes on the inside is an x-ray."

Zeke nodded, "I'll go fire up the machine."

"And I'll go get the patient ready," Kate added.

Kate and Karthey arrived in the x-ray lab minutes later. Zeke extended a hand.

"Hi, I'm Dr. Zeke Barnes," he said.

"I'm Karthey," the girl with golden-brown hair smiled at him and shook his hand.

"Dr. Kate tells me you're having headaches?" Zeke began pulling on a pair of surgical gloves.

"Yeah, I was," Karthey answered. Hope shone in her light-brown eyes, "Are you the head specialist?"

Zeke shook his head, "I'm afraid not; I'm just another doctor like Kate. Would you mind taking a seat?" he patted the back of an exam chair set up near the x-ray machine.

"We're just going to take some pictures of your neck, Karthey," Kate explained, "we won't know anything definite until the neurologist gets here and you can get an MRI, but at least this will give us a general idea of what's going on around that head of yours."

"Sounds good," Karthey confirmed.

"Okay, you're all set," Zeke stated, "Kate and I are just going to be right over there, operating the machine. You just hold really still till we say you can move, okay?"

"Got it," Karthey answered.

As the image of Karthey's neck appeared on the screen, Kate looked at it closely, hoping for some sort of answers that would tell them what Karthey had, be it a twisted disc, or a pinched nerve, or some sort of tumor-looking something. What she saw was unlike anything she'd ever expected. The image of a small white box showed up plainly on the x-ray image. Down near the clavicle, Kate saw another white object, starkly contrasted with the spine it paralleled.

She pointed to the objects. "Zeke," she gasped, "is this what I think it is?"

Zeke leaned in for a closer look. "I'll be durned," he muttered, "This girl has a cerebral shunt."

Kate left the monitor and returned to the room where Karthey waited. She noticed that the girl was obviously uncomfortable, and wondered if the pain had returned.

"Okay, Karthey," she told the patient girl, "you can move now."

Karthey sighed with relief and immediately began scratching her neck and behind her ear.

"Oh good," she sighed, "because I've had this awful itch ever since I sat down!" She rubbed her neck very hard, and Kate noticed it didn't take long for the skin to turn bright red. Immediately, Kate grabbed Karthey's wrist.

"Wait, stop," she ordered. She examined Karthey's neck closer. As she did so, Karthey began itching the inside of her arm, where the IV had been. Kate could see large welts developing, and leaning closer to Karthey's face revealed a faint wheeze. By now Karthey was frowning as if she desperately wanted to itch her neck again.

"Dr. Kate," she admitted finally, "I'm having a hard time breathing."

Kate knew she was having an allergic reaction. She had to act fast. "Karthey, you're having an allergic reaction. Are you _sure _you're not allergic to iodine?" Kate began gathering the necessary medications and antihistamines to stabilize the reaction.

"Pretty positive," Karthey answered, "about the only thing I'm allergic to is balloons."

Kate stopped with one glove on, the other halfway. "Wait, _balloons?_" she echoed. She looked down at her hands. With gloved hands she and Zeke had touched Karthey all around the areas in which Karthey now exhibited large, swollen hives. "Are you sure it's just balloons," she asked Karthey, "or is it _latex_?"

Karthey shrugged, "All I know is, I'm allergic to balloons. I can't ever touch them, or they make me itch, just like this."

Kate rolled her eyes and stripped the gloves off, digging in the cabinet for a box of nitrile gloves. "I'm sorry, Karthey; I think you might be allergic to my gloves; that's what's causing the reaction." She hooked a vial of antihistamine drip to Karthey's IV valve, "Here, this should counteract the reaction and make it stop itching."

Karthey's neck was red and no doubt sore by now. "Thank you, Dr. Kate," she said.

Kate knew that she needed to tell the girl about their discovery right away, and it probably wouldn't hurt to share it with Mrs. Devanne, either. Zeke came in and handed her the developed x-ray films.

Karthey noticed, "Are those the films?" she asked. "Can I see them? Did you find out what the problem was?"

Kate bobbed her head, "Something like that," she answered tentatively. "Okay," she told Karthey, "Let's go back to the exam room to look at them."

"All right," Karthey complied.

Kate and Karthey returned to the exam room, where Mrs. Devanne was still waiting for them.

"What did you find?" she asked when Kate entered the room.

"Well, Mrs. Devanne," Kate answered, flipping the switch on the lightbox and clipping the films against its surface, "we found two things: one, Karthey is allergic to latex rubber—"

"Oh! I'm sorry, I should have mentioned that!"

"—and two," Kate continued, pointing to the x-ray films, "Karthey happens to have a cerebral shunt, probably installed within the two weeks after her birth before she arrived in the foster system."

Martha's jaw dropped as she looked at the solid white objects that stood out next to Karthey's ghostly bones on the films. "But why wouldn't anybody know about this?" she gasped, "all the records described her as a healthy child with nothing wrong!"

"We'll get to the bottom of that, Mrs. Devanne," Kate promised, "meanwhile, this x-ray shows that the shunt is in fact broken, see how it stops just below the box—which, by the way, is a manual valve for the shunt—and continues down at the base of the neck? There should be tubing there, but it isn't."

Mrs. Devanne blinked wide eyes. "Well, that would explain the headaches," she concluded, but upon noticing Kate's dubious frown, she added hesitantly, "wouldn't it?"

Kate shrugged, "I'm sorry, Mrs. Devanne, but we can't know more about what's going on in Karthey's head until we can get an MRI."

"Do you have one of those here?"

Kate shook her head, "I'm sorry, we don't." Just then, she heard the front door of the clinic open, and Michael's familiar sigh as he made his way back through the crowds to the area behind the counter. Kate smiled, "But the man who _does _has just arrived! Come with me, Karthey!"

Kate Sykora bounced out the door and greeted Michael, who had just shed his overcoat and hung a stethoscope around his neck. "Good morning, Dr. Holt!" she cried cheerily, pulling Karthey forward by her shoulders.

The young woman hung her head shyly; Michael noticed lines of pain around her eyes. Why would Kate drag patients out to him?

"Morning," he muttered, "Who's this?" he extended a hand and tried to smile at her.

"Karthey," the girl replied softly.

"This is the headache case I called you about earlier," Kate explained to Michael, and turned to the girl, "Karthey, this is Dr. Holt; he's a neurologist. He can help you."

Karthey looked up at Michael, "Can you really help me?"

Michael raised his eyebrows at Kate. "I might; it depends on what the problem is."

Kate handed Karthey's file to Michael. "Turns out Karthey, here, has a cerebral shunt!" she declared.

Michael tipped his head, "Does she now?"

"Yeah, a _broken_ one," Karthey put in.

When Michael glanced at her in alarm, Kate explained, "We were able to see on the x-ray that the tube is separated from the valve behind her ear," Kate turned Karthey's head and pointed to the protrusion, "and continues about here," she laid another finger about two inches lower, just above Karthey's collarbone.

Michael frowned; this was certainly an unusual case! "That's not what I normally hear about cerebral shunts," he remarked to Kate.

"Is it bad, Dr. Holt?" Karthey asked, the fear showing plainly in her eyes.

Michael hesitated before answering, "I really can't answer that until we get you in for an MRI. That can happen—"

"At Holt Neuro, right?" Kate cut in, smiling in the way that Michael found so aggravating.

Michael sighed, "Sure; have her mother to drive her over, and I'll call Rita and get her set up for a scan while I get my work done here."

Kate's smile dipped; she hated it when Michael tried to dodge her obvious hints about the right thing to do. "Dr. Holt, can I speak to you for a moment?" She grabbed his arm and pulled him into her office.

After he'd closed the door, Kate didn't waste a moment.

"What the heck?" she demanded of the neurosurgeon, "You would ship her off to _your own office_, while you stayed here—to do _what,_ may I ask? Why wouldn't you go with her?"

"Now, hang on a sec, Kate!" Michael tried to defend himself, "I just got here, okay? No doubt Autumn's got a slew of patients in 'dire need of my expertise'—"

"Yeah, meanwhile, you have one right there who needs you right now!" Kate pointed out the door to where Karthey still waited.

"Kate, look at her," Michael instructed in a calmer voice. "If she was really having an emergency situation, she wouldn't even be standing upright, much less quietly like she is now."

Kate raised an eyebrow, "She's got at least twenty minutes' drip worth of Toridol in her system still."

"I really don't think that would make a difference in a worst-case scenario."

"All right," Kate fired back, undaunted, "So maybe she's not 'worst-case,' but what if she's 'bad case,' anyway? You'd want to be present if they found something in the scan that required surgery, wouldn't you? You wouldn't want to be in the middle of something here when _that _call came, would you?" She huffed, "and besides, since when were you ever so committed to your two hours here that you'd send a patient off without at least following her back to Holt Neuro?"

Michael sighed, not quite ready to admit that Kate was right, but at the same time realizing he had no other option.

"I just—there's just a lot going on at Holt Neuro right now," he said.

Kate snorted, "Oh, so now Clinica Sanando is your 'get out of dodge' place? I don't think so, Michael," she shook her head.

Michael sighed, "Fine; tell her mother to drive her over to Holt Neuro, and I'll follow them."

Kate's eyes danced, "Why don't _you _offer to drive her? I still have questions for Mrs. Devanne. She could take the bus and join you guys later."

Michael blanched, "What?"

"Come on, Michael," Kate sighed, "I really think this would be the best option. You could get her in there faster than Mrs. Devanne could. She needs help—_your _help."

Michael hesitated.

Kate smiled softly, "It's what Anna would do," she hinted not-so-subtly.

Michael tossed his head and stood. "All right, _fine!"_ He said. He returned to the hallway with Kate and gestured to Karthey, who was still standing with her mother.

"Come with me," he said, "I'll take you down to Holt Neuro myself."

Karthey glanced back toward Martha, who smiled encouragingly.

Kate spoke up, "Martha and I just have a few more things to discuss, and then she'll be right over as soon as we're done."

Karthey nodded.

"Shall we go?" Michael asked. He led the girl out of the lobby to his car.


	3. Chapter 3: Complications

Silently, Karthey followed him out the door, waited patiently as he opened the door for her, sat in the seat and buckled her seatbelt.

Michael got behind the wheel and buckled his own seatbelt. "All set?" he asked Karthey.

"Yeah," she responded quietly.

Michael pulled away from the clinic and started driving back to Holt Neuro. Karthey stared out the window and did not say a thing.

After about two minutes, Michael couldn't stand the silence. "So, uh," he fought for something to talk about, "what do you like to do, Karthey?"

Karthey considered before answering, "I like to write. And I like reading."

"A bookworm, huh?" Michael engaged her in the conversation.

Karthey smiled, "Yeah; Martha says I've been writing stories since before I could read."

"Martha?" Michael recalled seeing that name on Karthey's chart, "That's your mom, right?"

"Foster mom," Karthey corrected him, "but yeah. She took me in when I was only a week old, and I've been hers ever since. She's the only mother I've ever known, even if she's not my birth mother." Karthey sighed, "When I get married, I want to be a mom just like she is. I want to have kids of my own, and when they're grown I want to adopt." With that declaration, the car fell silent again and Karthey watched the skyscrapers roll by, the shops, the apartments. Suddenly, she turned to the man beside her, "What about you, Dr. Holt?" she asked, "Do you have any kids?" She glanced at his hand, and he knew she noticed that he still wore his wedding band.

"No," he answered shortly, "no kids; I was married once…but she died a while back."

Karthey blushed, "Oh," she muttered uncomfortably, "I'm sorry."

Michael shrugged, "It's all right; you know, sometimes these things don't work out. And besides, I have a neurology clinic and a family clinic to run." They pulled up in front of Holt Neuro, and Michael left his car with the valet as he escorted Karthey inside.

She gazed around in approving awe. "But if you have your own practice," she asked him, "Why do you work at the family clinic?"

"My wife was the director there," Michael informed her as they stepped onto the elevator. "I stick around for sentimental reasons."

The elevator let them out into the reception area. Rita was bustling around as usual—not much different from how he'd left her twenty minutes ago. She looked up in surprise.

"Michael, I thought you already left for the clinic, I—" she stopped when she saw the young brunette behind him. "Who's that? Oh, Michael," she gave him the well-known look that said _Not another Clinic patient!_

Michael confirmed her suspicions with a nod. "She needs an MRI, could you get her set up?"

Rita sighed, "All right. Hi there, I'm Rita," she greeted the girl, "Come right this way, and I'll get you started. What's your name?"

"Karthey Devanne."

Michael followed the pair as far as his office, where he ducked in to grab his white coat. As he emerged, a petite Asian woman caught his arm.

"Oh, Dr. Holt," Minnie Tanner gasped and asked him the same question she'd pestered him with all the previous day, "Have you found out about the alarm?"

Minnie's grandmother, Lianne Set, had come to Michael with a brain tumor and dozens of the typical geriatric medical conditions. They had removed the brain tumor successfully, but Lianne had never fully recovered from the operation because of her preexisting conditions, slipping gradually into a vegetative state, so that she was on full life support, all but unconscious, and carefully monitored and constantly visited by Minnie and her two brothers, Brian and Ethan. By far, Minnie was the most active in caring for her unresponsive grandmother, and lately she had been complaining about an alarm that seemed to only go off when Minnie was around.

"I'm sorry, Minnie," Michael tried to reason with her, "I've been a little busy these past few days. I'll have someone look into it, I promise."

"Okay, thank you Dr. Holt," Minnie rushed to return to her grandmother's side. Michael watched her go with relief. At least she wasn't the type to demand immediate action, and badger him into it. He owed her for the way she simply trusted him.

Michael spotted Rita coming out of one of the rooms, presumably the one where she had set up Karthey.

"She's ready for you, Michael," his faithful receptionist announced, "and the MRI lab is ready for her."

"Thanks, Rita," Michael smiled genuinely, "Say, Minnie keeps asking me about an alarm that is going off somewhere near Lianne Set's bed. Could you have someone check it out?"

Rita frowned, "Lianne Set? I don't seem to recall anything being the matter, and the last orderly to check on her didn't mention any alarms." She looked up at Michael, who didn't seem convinced, "I'll get somebody on it," she concurred.

Michael knocked on Karthey's door.

"Come in," she called.

Michael entered. Karthey was already dressed in a hospital gown.

"Ready?" Michael asked.

Karthey nodded.

"Let's go," he gestured out the door.

Michael seated Karthey on the bed of the MRI machine. He dug in his pocket for a fresh pair of gloves.

"Before we start, Karthey," he began, slipping them on and moving toward her, "I'd like to examine—"

"No!" Karthey cried sharply.

Michael stopped, "What's wrong?" he asked her.

Karthey looked up at him and pointed, "My throat and arms started swelling up at the clinic, and Dr. Kate said I was allergic to rubber."

Michael looked down at the latex gloves on his hands. "Oh, I'm sorry," he immediately apologized, "It's a good thing you caught me."

"I do _not _want to go through that again!" Karthey sighed in exasperation.

Michael changed his latex gloves for some nitrile ones, and commenced his inspection of Karthey's head. Near the back of her skull, Michael pulled back the hair in surprise. "Karthey," he asked, "did you know you have a scar back here?"

"No, I didn't," Karthey answered.

Michael grabbed her hand and guided her fingers to the spot, a small lump of flesh that was most certainly scar tissue, and a scar that extended about an inch beyond it.

"Wow," Karthey breathed, "I had no idea; I mean, I just thought it was a bald spot or something. You say it's a scar?"

"Yeah; hey, let's get that MRI going, see what we find."

"Okay," Karthey submitted as Michael instructed her to lie still as he started it up. He left the lab and went to the viewing room to wait for the scans to come in. Meanwhile, he called Kate.

"Kate here," she answered quickly. Kate always talked to him like she was really busy and didn't have much time for him.

"Kate, did you happen to notice the _surgical scar_ on the back of Karthey's head?"

"Whoa, whoa, _surgical_?" Kate repeated, "I asked Martha—Mrs. Devanne—about it, and she told me it was just a bald spot. I did notice the scar, but I just assumed it had something to do with the bald spot. You say it's surgical?"

Michael sniffed, "Well, I am a neurosurgeon; I know a surgical scar when I see one. Was anybody looking into information on the hospital where she was born?"

"Autumn tried," Kate explained, "but I guess Jane Doe had her baby at a pregnancy clinic that has since closed down. Mrs. Devanne was able to get the name of the place from the foster agency, but we can't find any contact info anywhere!"

"Okay, this girl has surgical scars on her body, a cerebral shunt that is now broken and who knows what else is wrong with it—and nobody can tell us _anything_? Could this be _any _more complicated?"

Kate bristled at Michael's incredulous tone, "Michael, it's not like we aren't doing anything here!"

The scans began showing up on the large bank of screens in front of Michael.

"I have to go," he told Kate. "Let me know if you find anything."

"I promise I will," she responded.

Michael looked at the screens, not sure if he could believe what he saw.

"Okay," he remarked grimly to himself, "this just got a lot more complicated."


	4. Chapter 4: Prognosis

Karthey lay still until the MRI technician told her, "We're all done, you can sit up now."

Karthey obediently sat up. She noticed through the window that the tech was the only one in the adjacent room.

"Where's Dr. Holt?" she asked the tech.

"Dr. Holt had to move on to other patients for the time being," the tech informed her, "he will be back to review your scans as soon as he is finished."

A knock sounded at the door, and Dr. Holt's receptionist and right-hand woman, Rita, entered the room.

"Hi there, Cathy," she said, "Dr. Holt got called away to some other patients, so I'm here to take you back to your room where you can wait for him."

"It's Karthey," the young woman corrected her, "but okay."

She followed Rita back to her room, and Mrs. Devanne helped reattach Karthey's IV and the heart rate monitor on her finger.

"Now you just sit tight till Dr. Holt comes," Rita instructed. "The IV drip should be finished in a few hours, and if he isn't here by then, I'll send a nurse in to remove it. Can I get you anything, Mrs. Devanne?"

The older woman shrugged, "A sandwich would be nice."

"Can I eat too?" Karthey begged, "I haven't eaten all day and I'm starving!"

"I'll check in with the café downstairs," Rita promised. "I'll tell them to send up sandwiches for you two."

"Thank you, Rita," Karthey called after her as she left the room.

Several hours passed until Michael finally had the time to return to Karthey with news of the results of her MRI. He entered the room to find the woman and her mother sitting at a table with café-vendor fare spread between them. Karthey was still dressed in her hospital gown, but she was smiling and laughing far more easily than he would have expected her to. Mrs. Devanne pushed the table out of the way when Dr. Holt approached.

"How did she do?" Mrs. Devanne asked, putting her arm around Karthey's shoulder.

"As well as can be expected," Michael tried to keep his voice optimistic. "When I looked at your scans, Karthey, and your ventricles look practically normal, though your shunt is indeed broken."

"Wait, I have ventricles in my brain?" Karthey asked. "I learned that the heart has ventricles in biology in high school, but the brain does, too?"

"Yeah," Michael pulled out a pen and picked up one of the paper napkins from the table. "See, so there's the two lobes of the brain, like this," he drew two hemispheres, "and within the brain, you have four ventricles, two in the lobes," he added two ovals within the hemispheres, "one in the middle, between them," another circle, "and a fourth just below that, which leads right to your spinal cord."

"Cool!" Karthey responded.

"The ventricles hold the cerebrospinal fluid, which acts as a buffer for the brain inside the skull," Michael explained. "It sort of gives the brain its shape, and keeps the spinal cord and the brain in alignment."

Karthey gazed at the diagram in enthusiastic wonder. "So what does the shunt do?"

"Well," _Here comes the hard part,_ Michael thought, "the amount of fluid in the brain and spinal cord is regulated by two glands in the brain: one produces the fluid, and the other absorbs it. The scar on the back of your head and the presence of a shunt indicate that you may have had an encephalocele removed."

"A what?" Karthey asked. "Is that like a tumor?"

"Sort of," Michael answered, "but not really. An encephalocele is just a sac of fluid and often brain tissue that escapes from the skull, which in an infant is not all one piece like it becomes when you're older. An encephalocele usually means there is a problem with one of the glands, either the producer or the absorber. We're trying to track down the hospital that did your procedure now, to see if we can get any more information about which it might be in your case. Either way, the cerebral shunt helps the draining process, usually providing another 'escape route' for the fluid."

"Usually?" Mrs. Devanne asked, "Isn't that what Karthey's shunt is doing?"

"Oh, I get it," Karthey spoke up, "It _was _doing that, but now it's broken, so that's why I was having the headaches."

"Not necessarily," Michael disagreed. "Karthey, have you recently experienced any violent head trauma, like your head snapping back and forth in a car accident?"

Karthey shook her head, "No."

Michael sighed, "Short of that, there's really nothing that could actually break a shunt tube like this, other than a long stretching over time, like a particularly fast growth spurt."

"So the break happened a long time ago?" Mrs. Devanne wrinkled her brow as she tried to understand what the neurosurgeon was saying. "But what about the headaches?"

Michael kept a neutral expression as he tried to reconcile what he saw with his own eyes with what they were telling him. He looked at the young woman. "Karthey, are you in any pain right now?"

"Right now?" Karthey repeated, "No, but—"

"The pressure headaches you were describing before were most likely caused because of a temporary blockage," Michael reasoned, "and if you're not in any pain now, the blockage must have passed. When I looked at your scan, Karthey, I saw that the end of the shunt isn't even where it's supposed to be. Right now it's sitting just outside your right ventricle, not inside it, where it should be. It's basically an unused piece of plastic in your head. There's no way to tell when that happened, but I can tell you for sure, if Karthey still has at this point in her life the same problem that she had when she was born and they put this shunt in, she wouldn't be standing upright right now."

"What are you saying, Doctor?" Mrs. Devanne asked.

"I'm saying that every so often, in cases that require intubation, especially congenital," Michael tried to explain, "a patient may become shunt independent—whatever was causing the problem at birth is no longer an issue once the brain has fully developed. Now, according to this MRI, I'd say the shunt has been ineffective for a good long while, much longer than just a few weeks ago, when you said the headaches started."

"So, but—" Karthey objected, "will the headaches come back?"

Michael shrugged, "They might, but I'm pretty sure that after this you'll be able to handle them with over-the-counter meds. I don't think they should be anything to worry about." He smiled reassuringly at the pair.

Karthey only half-heartedly returned his smile. Clearly she was worried, but Michael laid a reassuring hand on her shoulder as he escorted them out the door.

"It will be fine, Karthey," he promised her, "just focus on living your life. You have nothing to worry about."

"Okay," Karthey responded as Mrs. Devanne took her hand and squeezed it hopefully. "Thank you, Dr. Holt."

"Hey, no problem," Michael was getting used to waving off thanks, especially from Clinic patients, who regularly received more treatment than they deserved, if Michael Holt was concerned for their welfare.

"So what was it?"

Michael smiled and turned to face Rita. She had this odd habit of coming up behind him unannounced and asking a question. "Well, her shunt is currently sitting useless in her brain."

Rita raised her eyebrows, "Should you be so cavalier? That sounds serious."

Michael shook his head, "Her neurological reflexes are totally normal, and by now the headaches are gone. I think if it was anything damaging, it would have shown up."

"Let's just hope she's not going to slip into a coma tonight," Rita grumbled as she walked with Michael back down the hall.

Michael paused, "Oh, speaking of a coma," he remarked, "did anybody check on Lianne Set's alarm?"

Rita shook her head, "I really don't know what you or Minnie are talking about, Michael," she said, "I had Sharon check it out after Minnie left for the day, but there wasn't a sound, and all the monitors were reading normally."

Michael shrugged, "I guess that's that, then."

Rita pressed her lips grimly, "When were you planning on telling her that Lianne may never come out of her coma?"

Michael pursed his lips in thought. "Minnie and her brothers nearly forgot about Lianne after their parents died. If they knew she was a vegetable, maybe they would stop visiting her again."

"It'd be a lot quieter around here if they did," Rita grumbled.

"But then what would we do with Lianne?" Michael objected, "Legally, Minnie is the one who decides when to take her off of life support. If she stopped coming, when would we know Lianne was no longer viable?"

"Who's to say she's not already too far gone?" Rita inquired, but waved away any answer. "Moving on to more important things: are you going back down to the Clinic?" Rita asked merely for clarity's sake; she already knew the answer.

Michael spread his arms. "I still owe Kate the time today."

"I'm stunned to see you so noble," Rita remarked wryly, and returned to her desk in the reception area. "See you tomorrow, Michael," she hollered over her shoulder. "You should know that you'll have holdovers from today when you come in tomorrow!"

"Good night, Rita!" Michael responded. "I'll see them then!"


	5. Chapter 5: Consequences

True to her word, Rita had a stack of charts for Michael to review when he returned to Holt Neuro the next morning.

"Did you enjoy your evening with Dr. Sykora?" she asked smugly as Michael still rubbed his forehead to awaken himself sufficiently to read the finely-printed files in his hands.

"Oh, definitely," Michael quipped back, "we had a grand time! Stitched a few foreheads, diagnosed and treated a case of pneumonia, re-set a broken leg—"

"Sounds like quite the party!" Rita shot back. "Oh, and Minnie has already called about her grandmother, and I told her about it. She said she'd be in after work today."

"Great!" Michael replied without really meaning it, "I'd better get as much done as I can before she arrives!"

"You do that, Dr. Holt," Rita agreed.

Michael adjusted the collar of his lab coat and commenced the work he loved in the field he knew best: helping people make sense of what was going on in their heads. By lunchtime, he had seen most of the pressing cases, performed two cranial operations, and was feeling the need to stretch his legs and get some fresh air. He hung his lab coat in his office and grabbed his overcoat off the hanger.

"Rita, I'm going to take a walk and get some lunch, okay? I'll be back in about an hour," he told his faithful assistant.

"I'll hold the fort till you get back, Michael," she promised.

No less than half an hour after Michael left, Rita was surprised to see a familiar face step out of the elevator and glance around her desperately: the Clinic patient from the day before, Karthey Devanne. The young woman's face was drawn with pain, and she had a hand plastered to her forehead. She ran over to Rita's desk.

"Rita?" she begged, blinking furiously, "Please, I need to see Dr. Holt; it's an emergency!"

Rita tried to overlook the breach of protocol. She smiled at Karthey, "Well, Karthey, it's good to see you again. I'm sorry, but Dr. Holt is away at lunch right now, and he's completely booked with other patients for the rest of the day. Holt Neuro doesn't usually take walk-ins, but I can schedule you an appointment later.

Karthey grimaced and hung her head, a sure sign, Rita knew, that something was definitely wrong, "_Please_," her voice was hoarse and desperate, "I need to see him right away! The headaches are back, and they won't go away!"

Just at that moment, who should return but Michael Holt, himself. He walked over to the desk.

"Karthey?" he asked.

She turned to him, grasping his arm desperately, "Dr. Holt, the headaches are back, and the pain relievers aren't working, and now—" she gulped and clenched her eyes shut as the pressure surged within her brain, "I can't see straight," she whispered, chin trembling as she fought back tears.

"Okay," Michael immediately resumed his persona as Dr. Holt, Brain Surgeon, and gestured to Rita, "Rita, take her back and let Trish know she'll need a CT scan, and I'll need to look at her MRI again. I'll be there in a minute." He turned back to the patient, "Karthey, we're going to get to the bottom of this. Where's your mom?"

"Martha dropped me off here," Karthey explained, "she said she'd be up as soon as she could find a parking space."

"All right," Michael was off down the hall toward his office.

Rita came around her desk and called after him, "What about your 1 o'clock appointment?"

"Move it!" Michael called over his shoulder.

Rita sniffed, "Well, come with me, Karthey."

"Okay," Karthey replied, gritting her teeth against the surging pain in her head.

By the time Michael returned to the room Karthey had after her scan, Mrs. Devanne had arrived. Karthey sat on the end of the bed.

"All right, Karthey," Dr. Holt began, coming over and beginning his customary inspection of her head, "do you want to tell me when the headaches and the blurred vision started?"

"Well," Karthey sighed, "pretty much as soon as we got home, the headaches began to come back, gradually. I took some Advil, and I wasn't sure at first if it would work, but it took this time, and the pain went away, just a little. Then, while Martha and I were watching a movie after dinner, I noticed that the picture seemed fragmented unless I closed one eye."

Michael paused, feeling no abnormalities or soft spots on her head, and looked at Karthey, "Fragmented?" he repeated.

"Yeah, like what one eye was seeing was sort of—I don't know—out of alignment with what the other eye saw. It was clearer if I closed one eye, but there was no way I was watching the whole movie like that!" Karthey sighed, "I tried to focus, to make my eyes see the same, but every time I tried that, it made my forehead hurt."

"And does it still hurt to focus now?"

Karthey closed her eyes and rubbed her forehead, "Yes; even in this normal light, my forehead hurts." She bit her lip, "and I think it must be getting close to the end of my last dose of Tylenol, because the pressure in the rest of my head is back again."

Michael pressed his lips and huffed out his nose, stepping away from the bed and sliding down the dimmer switch on the wall. "Karthey, if you don't mind, I'm going to check your eyes."

"All right," the girl complied.

Michael pulled out his ophthalmoscope and held Karthey's eyelid open. He peered through the window into her eyeball.

"Yep," he said finally.

"What do you see?" Mrs. Devanne asked anxiously.

Dr. Holt turned to the woman with a grim expression. "Karthey is exhibiting the early symptoms of mild papilledema."

Karthey furrowed her brow at the long, unusual word. "Papilla-what?" she inquired.

"It's a swelling of the optic disc at the back of the eye, typically caused by pressure from the brain on the optic nerve," Michael explained.

Mrs. Devanne shrugged, "That doesn't sound so bad when you explain it that way; is it serious?"

Michael nodded, "If whatever is going on in Karthey's brain is not resolved, she will certainly go blind."

The word hit Karthey like a shot. Her expression read sheer terror as she cried, "_Blind_! What can we do? I don't want to go blind! Please help us, Dr. Holt!"

Michael sighed; as much as he wanted to help, as much as he probably had the skills and the tools to help Karthey reach a definite diagnosis and possible cures, what he lacked was time and space. He knew that the longer he spent with her, the more his regular cases would continue to pile up. He thought carefully before answering, "I'll tell you what: unfortunately I have my own patients here to take care of, but I can refer you to a buddy of mine, Dr. Medino, who is a neurologist at Manhattan Memorial. The quickest way to get a consult with him is by going through the ER. When you do talk to him, tell him that I said you need two things: an MRI with contrast dye, so we can see how the fluid is flowing in your brain, and a lumbar puncture. Once that's done, have him send me the results, and give me a call if you have any questions about what he recommends, okay?"

Karthey was visibly disappointed that Dr. Holt would not be the one to help her, but at the same time she accepted there was nothing she could do about it. "All right," she replied. "Thank you, Dr. Holt."

Michael smiled as Karthey stepped off the table and prepared to change out of the gown. "Glad I could help you, Karthey," he said. As he watched her walk away, Michael couldn't help sighing to himself, "That should keep her busy for a few days." The whole situation was not as conclusive as he would have liked, but Michael held onto the fact that it was the best he could do under the circumstances.

His phone rang. Michael checked the screen; Kate Sykora was calling, and Michael was pretty sure he knew why. "Hey, Kate," he answered.

"Hi Michael," Kate's voice was quick; it sounded like she had something exciting to share, and only a short time to tell it. "Is Karthey still there?"

"Nope," Michael replied, "you just missed her."

"What? Where did she go? What happened?"

Michael laughed at Kate's tone and reassured her, "Nothing serious; I took a look at her and didn't see anything too incredibly alarming, so I sent her over to a colleague of mine at Manhattan Memorial; he should be able to take just as good care of her as I have."

Kate gasped, "Manhat-_Michael_!" she chided him, "You passed the buck, didn't you?"

Michael defended himself, "Look, Kate, I did as much as I could, but I have too many other patients to give Karthey the time she needs to get what she needs."

He heard Kate scoff, and knew she didn't believe he was doing the right thing. However, she put that situation aside and continued, "Oh, speaking of switching hospitals, I think I've finally found the truth behind Karthey's birth."

This was something Michael had been wondering if he would ever know. "Oh really? And what would that be?"

Kate launched into her story, "Okay, so the clinic where she was born is closed down now, but I checked hospital records from the nearby area, at about the time Karthey was born, and I called neurosurgeons who would have been on duty at the three or four likeliest hospitals at the time, and…I found him."

"Found whom?"

"The neurosurgeon who operated on Karthey! He said it had been a favor called in by a friend of his who worked at the clinic, and he had agreed to operate on a Baby Doe with an encephalocele, and almost as soon as he sent the baby back to the clinic, Jane Doe disappeared. He said he called his friend a week later and they had just found the mother dead in the street. She'd run off and left the baby."

"Separation anxiety, no doubt; so then it took about a week to register Baby Doe in the foster system, and you have a two-week-old orphan with a shunt no one knows about," Michael concluded. "That makes sense."

"Oh, it totally does!" Kate agreed enthusiastically.

Just then, Michael heard a door close and Minnie Tanner's anxious voice, "Dr Holt?"

Michael kept his back turned just long enough to hide the fact that he was rolling his eyes. "Kate, I've gotta go," he said.

Luckily, Kate caught his tone and understood. "All right; see you later," she replied.

Michael hung up the phone and turned to face the young Asian woman. "Yes, Minnie, what can I do for you?"

"Dr. Holt, do you have a minute?" Minnie asked. She latched onto his arm and began pulling him back down the hall to her grandmother's room. Michael checked over his shoulder and, sure enough, faithful Rita had just peeked around the corner to see Minnie dragging him away. She did not move to stop them, but Michael was sure he felt her death glare as the longer he indulged Minnie meant less time seeing scheduled patients.

As they approached the room full of comatose patients, Minnie explained, "I think my grandmother is out of her coma."

Michael stopped in his tracks and pulled his arm out of Minnie's grasp, "Minnie—" he protested, but she cut him off.

"No really! Come see!" She forged ahead, continuing, "I think she responds when I talk to her. My brothers and even my husband think she's a vegetable; that's why they never come, and they think I'm silly for coming." The two of them entered the ward as Minnie finished, "I still hear the alarm, it's so quiet in here with all the other comatose patients, but I think since no one else seems to hear it, I should just forget about it. Look at her, Dr. Holt!" Minnie's tone was desperate—yet hopeful. She gazed at her unconscious grandmother, "I think she can understand what I say, even though she can't respond."

For the first time since entering the room, Michael realized that Minnie had been right all along: there was an insistent beeping emanating from somewhere around Lianne Set's bed. "Wow, Minnie," he shook his head, "you're right; that would get annoy—" His voice faded as he realized there was something odd about the beeping; it wasn't completely consistent, like an alarm; but there was a definite pattern to it. Michael frowned in concentration, and Minnie noticed it.

"What is it?" she gasped quickly, evidently fearing the worst.

Michael did not answer her question directly, but asked his own. "Wait a minute," he remarked, "Chiang-Yun Set was a telegraph operator, wasn't he?"

Minnie raised her eyebrows in puzzlement, "Grandfather?" she clarified, "Yeah; why?"

Michael immediately dove for the pen and small notebook he always carried in his lab coat pocket. "That's not an alarm," he told Minnie Tanner, furiously jotting down the series of dots and dashes according to the pattern he heard. "That's Morse code," he announced triumphantly, showing Minnie the paper.

Minnie tilted her head, "It is?" she asked incredulously. She listened closely, her eyes following the dots and dashes on the page as her ear matched them to the beeping sounds she heard. Her eyes widened, "It is!" she cried. She handed the notebook back to Michael. "What does it mean, Dr. Holt?"

Michael quickly grabbed his smartphone and looked up the Morse code alphabet. Soon, the message was translated. He read it to Minnie: _"I hear you, Mouse."_

Michael wasn't sure what the message meant, or if he had translated it correctly, but the effect on Minnie was so swift and sure there could be no doubt. Her hands flew to her face, and her knees buckled. "_Grandma_!" she shrieked. Before Michael could stop her, she grabbed her grandmother's hand. "It's me! Your Minnie-Mouse! I'm here! I hear you too, Grandma!" She turned her eyes toward the notebook in Michael's hand. "May I keep that?" she asked him.

Michael shrugged and handed it to her, "Sure; do you need my help, or can you decode it yourself?"

Minnie shook her head, "Oh no, I can do it; now that I know it's Morse code, I can talk to her." She stopped and pressed her lips, "Will you try to contact my brothers for me?" she asked, "I know they will come once they learn she's still alive."

Michael tried to keep a smile on, even though he knew he was late making his rounds. "Sure, I can get someone on that," he responded.

"Thank you so much, Dr. Holt," Minnie's voice was genuine as she clasped his hand gratefully.

Michael didn't quite know what to say; there were no words for how and why a comatose patient would suddenly awaken and begin communicating in Morse code. Minnie Tanner stayed there at her grandmother's bedside till Michael finished both his rounds and his paperwork. He poked his head into the room. "Minnie?" he called to her, "It's about time to close up. You can come back tomorrow. Your brothers will be here, too. Rita called them."

Minnie finished the last sentence from her grandmother, grabbed her things, and ran to the door. "Oh, thank you, Dr. Holt!" she cried. "See you tomorrow!"


	6. Chapter 6: Family Values

The next morning as Michael walked into the office, he found Rita waiting for him just outside the elevator.

"Drink that and follow me!" she ordered, handing him his daily green juice.

Michael could hear shouting emanating from down the hall. "Who is that?" he asked.

"That is the sound of a Tanner-Chung reunion," Rita explained, "No wonder they've avoided each other for so long. It started about as soon as they got here, and it hasn't quit! I told them they had to wait for you to see Lianne, otherwise they'd be shouting in there, too."

Rita and Michael entered the waiting room. Minnie was in a heated argument with one of her brothers, even as she was barking out orders to the other two, one of which was busy insulting Minnie's husband George.

"You go in first—no, Brian has to wait! Ethan, you go in second! Sit there! You will be at the foot of Grandmother's bed. No! You don't talk to my husband that way, Ben! Apologize, now! Straighten your tie! Tuck in your shirt! Don't spill anything! Oh!" She clapped her hand to her forehead, "I just want everything to be perfect for Grandma!"

"Minnie?" Michael asked, hoping to intervene.

The young woman turned to face him. "Oh! Dr. Holt! All right, can we see our Grandmother now?"

Michael surveyed the group. Minnie's brothers stood behind her, looking neat and tidy but also somewhat cowed and humiliated. George stood a respectful distance from them, watching Minnie.

"Sure," he told her, "I think it would be fine—as long as you are not disruptive of the other patients or the staff."

Minnie immediately turned on her men, "All right, you heard the doctor! That means no talking out of turn, no fighting, and we'll take turns going in! Ben and I will go first, then Brian and Ethan, you can join me when Ben comes out, and George comes last."

"Why do you get to stay the whole time?" Brian demanded grudgingly.

"Because I am the one who knows what Grandmother is saying!" Lianne declared.

"Excuse me," Michael interposed, "I'm just going to make my rounds now."

"All right, Dr. Holt," Minnie replied, "thank you." She returned to putting her brothers in their places.

Once Michael was finished with his morning routine at Holt Neuro, he hung his lab coat on the hook in his office and grabbed his trench coat and scarf.

"Going to pay your respects at the Clinica?" Rita asked knowingly.

Michael nodded; he glanced down the hall to the coma patient ward. Ben and George sat there, three yards apart, but not speaking a word to each other, not even looking at each other. He nodded toward them while looking at Rita.

"Keep an eye on that group, okay?"

Rita nodded, "Say hello to Kate for me."

Michael grinned, "Will do."

The Clinica lobby was as full as ever with screaming babies, dirty hoboes, and antsy children.

Anton greeted Michael when he walked in. "Good to see you, brother," he murmured calmly.

Michael grunted a quick, "Hi Anton," as he slipped on a fresh lab coat and stethoscope. It still felt weird every time Anton called him that.

Kate came out to see off another patient. She issued final instructions and turned to Michael.

"So how's Karthey?" she quipped, arching her eyebrows.

Michael smirked, "Nice to see you, too," he responded. "I'm sure she's doing just fine."

"You're sure? But you don't know that!"

Michael huffed, "Abel Medino is a good friend and a great doctor! I trust him!"

"More than you trust yourself, apparently!"

"Excuse me!" A woman's voice interrupted their subdued spat.

Kate and Michael turned to face the speaker, a tall woman in her late fifties dressed in a black pantsuit and bright, chunky jewelry. Beside her stood her husband, a clean-shaven man who had his arm around the shoulders of a young boy of about thirteen.

The woman extended her hand, "I'm Karen, this is my husband Trent, and you must be Dr. Holt. The man at the desk said you could help our son Matthew."

Michael surveyed Matthew. Other than the fact that he seemed to be the type who amused themselves by studying their shoes, there were no other visible signs of a problem. He shrugged. "Sure," he told Karen. "Follow me."

Michael was prepared to get right down to the issue with checking over his patient, but the minute he asked, "So what seems to be the problem?" it was clear that Karen, too, was prepared.

"Our son had always been a quiet child, mostly keeping to himself. He is happiest in his own little world."

"Especially if that world includes a piano," Trent muttered.

Michael noticed that Matthew was busy drumming on his knees as if he had a keyboard perched upon them. "You like the piano, do you, buddy?" he tried to engage the young man.

Karen leaned forward and tapped the edge of the table next to Matthew. In rhythm with her hands, she prompted in a singsong voice, "_Answer the man, please, Matthew_."

Matthew, to Michael's surprise, responded in kind, replying in his own melody without missing a beat. "_I love the piano; it's my favorite instrument!"_

Michael watched this exchange with interest. "Well," he remarked when Karen sat back, "His vocabulary is strong enough."

"Trent and I have ensured that he has not lacked anything in the way of education," she said with certainty, "even if the tutors had to come to our house, and be able to play the piano in order to get him to listen. He is a brilliant musician, our little musical _protégée_," she pronounced the malapropism with finesse, unaware that the correct term was "prodigy," "and we hoped to send him to Carnegie-Mellon, where I'm sure he'll do famously, but—" she frowned, "we can't get him to concentrate long enough to get his grades up. We've tried intensive tutoring, advanced placement, accelerated classes, even, but nothing works." She gazed sadly at her son, "It just burns me up inside to see such a marvelous talent go to waste. Do you know of anything that could help him behave normally? Is it ADD, do you think?"

Michael watched Matthew for a long time. He was still drumming away, oblivious to the people around him—but sitting very quiet and very still. A child with attention deficit disorder would be roaming the room, looking for something to catch their attention, if even for a moment. Matthew, on the other hand, seemed fixated on one thing alone.

Michael turned back to Karen. "Have you considered that Matthew might have autism?"

Karen seemed horrified at the suggestion. "Are you implying that our son is mentally deficient? I assure you, when the tutors are working with him he does phenomenal schoolwork. Matthew is not handicapped!"

Michael sought to reassure her, "I never said he was. Studies have shown that autistic individuals are only lacking in some social skills. Mentally, they can often be brilliant, especially if their fixation involves some sort of skill…such as music."

Michael saw Karen look at her son very differently. Instead of anxiety, he saw curiosity. He felt like a hero as he stood. "Well, since we've diagnosed the problem, let me tell you how we can help: I'm going to send you to Autumn, who is a social worker, and she can recommend some tutors and programs specialized for autistic kids, and they will help Matthew flourish within his condition." He walked the family out of the room and waved Autumn over.

Karen turned to him, "Thank you so much, Dr. Holt!" she gushed.

He smiled. "Don't put away those dreams of Carnegie-Mellon just yet," he encouraged. As the family left, he checked his watch. "All right," he told a harried Kate as she passed, "I'm out of here; good luck on the rest of your day!" he traded the lab coat for his overcoat.

Kate rolled her eyes and did not respond.

The rest of the day was as smooth as Michael could wish. The Tanners and the Chungs left around three-thirty, and Michael performed three minor cranial operations over the course of the evening without missing a stitch. At the end of the day, he hung up his lab coat and relaxed at his desk, mindful of a day well-spent. Michael noticed that his inbox held and e-mail from Dr. Medino. He opened it.

Attached were the contrast-MRI scans. They confirmed that flow through the brain was sluggish in some areas, backed up in others.

_Dr. Holt, _the e-mail read, _Attached you will see the scans from Karthey D., the patient you referred to me yesterday. A lumbar puncture, administered with the patient laying prostrate, revealed about 53 cmH__2__O in Karthey's spinal cord. Such inordinate pressure, as you know, would require immediate surgery. I met with the mother and daughter after the puncture to discuss treatment options._

_ The first option I gave was an endoscopy. Further inspection of the MRI image may indicate stenosis of the aqueduct between the third and fourth cranial ventricles. An endoscopic ventricular bypass of the fourth ventricle, creating a new pathway from the third ventricle straight to the spinal cord, could solve this issue. However, as I expressed to Karthey and her mother, such a procedure runs the risk of disrupting the hypothalamus and also carries the risk of short-term memory loss._

_ The second option is to install a new cerebral shunt, if indeed an effective drainage system is what she needs. I communicated the necessary risks and projected failure rate with complete honesty. They said they would discuss the options, as neither sounded very pleasant at first, understandably so. I anticipate reaching a decision in the next couple weeks. I did warn them that whichever procedure they chose, Karthey should not leave Manhattan for at least a month…._

Michael shook his head as he finished the e-mail. Something told him he would be getting a call from either Martha or Karthey the next morning, for sure!


	7. Chapter 7: Risks and Relationships

When Michael Holt reported to his office at eight o'clock the next morning, Rita waltzed in with the day's agenda.

"The Chung brothers and the Tanners will be here at nine," she informed the neurosurgeon, "They would have been here by now, but I thought you might need time to gird your loins before facing the onslaught."

Michael hung his head and laughed to himself at Rita's unabashed use of the most outrageous yet appropriate metaphors.

"Have either of the Devannes called yet?" he asked.

Rita shook her head, "No, but remember you have the Clinica at ten."

Michael waved his hand dismissively. Just then, the phone rang. Rita dutifully checked the caller-ID.

"That would be the call," she announced. "I'll just go back to my desk."

"Thanks Rita." Michael picked up the receiver, "Hello," he said, "this is Dr. Holt."

"Dr. Holt?" Karthey's voice was furtive, and strained. Michael knew she was worried, so he opened the e-mail from Dr. Medino and tried to keep his voice light and cheerful.

"Karthey," he said with a smile, "How was your appointment? Dr. Medino sent me the scans; I see the MRI told us what we needed to know."

"Yeah, I guess so," Karthey was still unconvinced.

"How is the recovery from the lumbar puncture? I hear your pressures were really high."

"The recovery has been fine. I'm lying down right now. I don't know if they were high; all I know is that it was the first time that the pain was completely gone without the use of painkillers. I could literally feel the fluid just rushing from my head." The young woman sighed, "He gave us two options for surgery; I wanted to ask you about them."

Michael pulled up the e-mail, "Yes, he notified me of the results. I must say, I thought I'd seen everything but your case looks particularly—unique."

Karthey sighed, "I know! I never thought I could find relief, but when they tapped in and drew off the fluid I could literally feel the pressure leaving my head."

Michael chuckled, "And now?"

"Pain-free; well, except for the spinal headaches, of course, but those were _nothing_ compared to the last month!"

"So what about the surgery options?"

Karthey's tone dropped considerably. "I didn't really like either odds, Dr. Holt. It seems like I'm committing to either a deficient quality of life or a slow but certain death."

Michael frowned, "What did Dr. Medino tell you?"

"Well, for starters, he showed us where the aqua-something—"

"Aqueduct?"

"Yeah, where it was pinched off—only he didn't quite use that word…"

"Okay, yeah, I saw that too."

"And when he was talking about the surgery options, he said that the endoscopy would be the best to solve the problem, but at the risk of my short-term memory…" Karthey sighed again, "Dr. Holt, I'm going to college this fall; I _need _to be able to learn new things and remember them!"

"What is your concern about the revision?"

"The failure rate, mostly, that's what scared me. The margin just seems too big; a twenty-five percent failure rate sounds just big enough for me to fall in it."

"Twenty-five?" Michael echoed, his voice communicating the concern he felt; where were these numbers coming from? Perhaps in owning his own practice so amply equipped had placed him a world apart from the "normal" surgeons. His own average of failed revisions (as the operation was called) was below ten percent; nationally, the failure rate hovered just above that. He frowned. "Karthey, why don't you and Martha come in to Holt Neuro, and I'll see what I can do."

"Really?" she gasped.

Rita had returned to the office to catch the last part of his conversation. She immediately flipped open his schedule and laid it on the desk, pointing to a blank. She smiled as Michael informed Karthey, "It appears I have an opening at 11 this morning. Can you make it?"

"We'll try!" Karthey promised, "Thank you, Dr. Holt!"

"My pleasure," Michael replied, and hung up the phone.

"Well, sounds like you have a full day now, Michael," Rita remarked as she updated his schedule with Karthey's appointment. "Weren't the doctors at Manhattan Memorial able to assess the problem?"

Michael frowned and stroked his chin. He pulled up the MRI scan. "This is what her brain looks like," he told Rita. "Abel informed me that the lumbar puncture revealed pressures of 53 cm H2O in her spinal cord." He highlighted the area between the third and fourth ventricles, the one that Medino had said appeared too narrow to afford adequate flow of fluid. "This may be our problem here."

Rita blinked, "Now, Michael," her voice carried that patronizing tone she used whenever she thought he was missing something, "I keep a garden behind my house, and I water that garden with a hose."

Michael grinned, "I knew it!" he cried. "Somehow, you always struck me as the gardening type.

Rita forged ahead, "When I'm watering with the hose, and I pinch it off in a certain point, it stands to reason that one side will receive less pressure—"

Michael nodded, "The side in front of the kink."

"—While the pressure increases on the other side."

"The side receiving flow from the faucet, but the water has nowhere to go." He stopped as the effect she was describing played out in his mind.

Rita saw the connection coming, so she merely mused, "I wonder how the pressure could be so high lower in her spine, when it's been pinched off up near the brain stem." She left the office.

As soon as she exited, the Tanners descended upon Rita.

"Ms. Rita," Ben complained, "This arrangement is not working for us."

Rita steeled herself for what was to come. "What arrangement?"

"Lianne's communication in Morse code," Ethan answered, "It's too slow. We need to find out what she wants done with her stuff; she has a will, but it's not very specific. We are trying to clean out her living quarters, but she has a lot of old junk that is not mentioned in her will. We need to go faster. You need to tell Minnie to go faster!"

"Where is Minnie?" Rita asked.

Ethan pointed her to the waiting area near the comatose wing.

Minnie sat upon a couch, crying softly into a tissue.

"Minnie," Rita said gently, taking a seat next to her.

"Oh Ms. Rita!" Minnie sobbed, "I'm trying to do what my brothers ask! They say they want answers right now, and I am trying to translate the letters as quickly as I can, but Grandma Lianne, you know, she only goes at one pace, and there's nothing we can do about it! I'm trying! I want to honor her. But she forgets a lot of things, and she gets confused when everyone talks at once, and it makes her communicate even slower!"

Rita put a comforting arm around her as she sobbed. She looked around at the four men gathered in the room.

"Now, you all listen well," she broke out sternly. "You know that what you have is a gift. Not many people can communicate with a loved one beyond the reach of medicine, just waiting to die. You're lucky she didn't pass away before you all got here! Tell me this, if she had died suddenly, what would you have done with all those things?"

The younger men stared down at their hands. George Tanner spoke up, "Probably tossed a lot of it; it just looks like a bunch of junk to us."

Minnie's head flew up, "No!" she cried. "I am sure there are many things of value, from her heritage!" she turned to Rita, "That is what we are finding out from Grandma Lianne; the things she remembers are the most valuable to her. I want to keep those things. But George and my brothers don't want to wait for an answer!" She glared at them.

Rita nodded and stood, bringing Minnie with her. "This is your chance to communicate with your heritage before it is lost forever. Just give it time," she looked meaningfully around until all met her gaze, "be patient. You may never have this chance again."

They all nodded.

"Thank you, Ms. Rita," Ben said as she moved to resume her post at the front desk.


	8. Chapter 8: Resolution

Michael, inspired by what Rita had told him, reviewed Karthey's scans again. He considered the location of the shunt. There was nothing to tell him whether it was working or not, but as he clicked through the layers, he discovered that it wasn't buried in tissue at all, only pulled away from the main ventricle in it's own little pocket. Perhaps this is what caused the pressure to build in the ventricles, expanding them past their normal capacity. He knew that a hose, pinched off on one side, would "inflate" under the added pressure of the water-flow, giving the appearance that the kink might be smaller than it really was. What if the real reason for giving the appearance that the duct between the third and fourth ventricles was the fact that these two ventricles were ballooned past their normal size, and the duct wasn't blocked in any way at all?

"In that case," he told himself, "The answer is obviously shunt revision." But how? Dare he risk removing the old tubing? He pulled up the "shuntagram" he had taken on Karthey's first visit, when the headaches proved to be shunt-related. The tubing was indeed torn at the clavicle, and he could clearly see where the material had actually calcified to the ribcage. Such a thing certainly happened a long time ago.

"Well that's certainly not something you see every day," a voice spoke behind him.

Michael knew who it was without turning around. "I'll admit, it's one of the more challenging cases," he told the ghost of his ex-wife, Anna.

She surveyed the screen over his shoulder with concern, "She came to you with headaches?" she referred to his notes about Karthey.

"Yeah; apparently her shunt decided just now to bite the dust. To think she could go her whole life without even realizing that it was there, if this hadn't happened!"

"I remember several incidents of hydrocephalus in Alaska," Anna said faintly. "Most of those children died before we could do anything about it." She smiled, "This girl has someone watching out for her; she's lucky to have only had an encephalocele to alert the doctors about her condition."

"Not to mention that she's never had a problem before now," Michael agreed. "These things are supposed to only last, what, five? Eight years?"

"How old is she?"

"I think she's about eighteen or so."

"Lucky indeed," Anna nodded. "So what are you going to do?"

"I think a simple shunt revision would solve the issue," Michael answered promptly. "I would just need to insert the new tube alongside the old one, and voila!" He spread his hands for emphasis.

Anna frowned, "More tubing in her abdominal area?" she questioned skeptically.

Her tone grated on Michael. "Yes, it's the only way. You see this here?" he gestured to the ribcage, "The tubing has pretty nearly become part of the bone. If I did try and pull it out, it might leave shards of calcification or even tubing behind, which could cause great damage to the tissue. At least we know that such as it is will remain harmless."

Anna sat on the desk in front of him, staring deep into his eyes. She smiled. "What about children?"

Michael shifted in his chair, "Children?"

"Yes; does Karthey want to have a family someday?"

Michael shrugged, "Well, she's said as much, I guess."

"And don't you think having all that extra tubing in her abdomen might get in the way of that?"

Michael rolled his eyes, "It's not my problem to deal with; there's nothing else I can do about it."

"Take the tube out, Michael."

"It's too risky."

Anna actually threw her head back and laughed loudly, "Oh-ho! Be it never said that Michael Holt is a coward! I thought I was the one who objected because of risk, and you were the one to rationalize them away!"

"Well—"

"So, Michael, rationalize this!"

"It's not my life!"

"Mine wasn't, either!" Anna bit her lip when she saw how her words jolted him. She continued quietly. "Are you saying that nothing in your training has prepared you for this?"

Michael dropped his gaze, "Well, no; I know exactly how it _should _work," he admitted.

"Then Michael," Anna waited till he looked up at her. "Do it; you have the skill. If there is anyone in New York qualified for this procedure, it's you." She raised his hand and clasped it in hers, tracing his fingers with her own. "These hands are very careful and very gentle. They've saved so many lives doing things no one else thought possible—taking _risks._ I believe you can do it, Michael," she looked at the screen, calling his attention back to it. Even as she said the words, he could see clearly now what had been invisible before, a way that he could actually work around the calcification to extract the most amount of tubing with minimal tearing. He nodded.

"Okay Anna," he said, "I'll do it—" By the time he turned around, she was gone.

Karthey proved admirably punctual. Emerging from a post-op at 11 o'clock sharp, Michael met Rita in the hallway.

"Karthey's waiting in Room 5," she informed him.

Michael did not have to miss a step as he proceeded down the hall to her room.

"Good news," Michael said as he entered the room and sanitized his hands. "Karthey, you need a shunt revision."

She frowned at him, "That's supposed to be good news?"

Michael nodded and took the seat next to the bed. Mrs. Devanne sat by the table at the foot of the bed, anxiety creasing her face.

"It is," he affirmed, "because I am going to be the one to do the surgery."

Karthey sighed and ran a hand through her hair. "Okay; Dr. Medino said I might consider postponing college for a month, so that I would have time to plan the surgery within the next couple weeks, and at least a month of recovery."

It was all Michael could do to keep from smirking. "If all goes well, Karthey, I don't see that you'll be needing more than a week of recovery. And if you're worried about being ready for college in time, I can do the surgery tomorrow."

Karthey nearly started off the bed. "_Tomorrow_?" she shrieked. Michael clearly saw the fear in her eyes.

"I can shift my schedule so you'll be my first patient," he explained, trying to calm her down, "We can start the pre-op stuff today and by this time tomorrow it will be done. You don't have to worry, Karthey. I'll have you know that the national average failure rate for shunt revisions is right around eight to eleven percent, and often the kids who need them have more health issues than you do."

"What's your average?" Karthey muttered, still stunned.

Now Michael smiled, "Last I checked it was below seven percent."

"See, Karthey?" Martha encouraged, "You said yourself that you'd consider anything less than ten percent a small enough margin!"

Karthey covered her face with her hands. "But…" she spluttered, "Tomorrow! I can't do _brain surgery_ tomorrow!"

Martha rushed to her daughter's side and slipped a comforting arm over her shoulders. She looked up at Michael. "Dr. Holt, having two weeks to prepare for something like this is one thing; having less than twenty-four hours is another. Could you give us a while to think this through?"

"Sure," Michael agreed immediately. He stood, "Take all the time you need. I'll be by again around five to see how you're doing."

"Thank you, Dr. Holt," Martha nodded to him. Karthey wouldn't look up.

Michael moved on, and on his next gap between appointments paid a visit to the comatose wing. He smiled to see the Tanners and the Chungs finally happy to be around one another, enjoying one another's company and bearing with the gradual pace of Lianne's steady "beep-beeep-beep" of her call button. He approached the group just as Minnie read out the message: "_Goodbye, my children. I love you."_ Her hands shook as she reached for her grandmother's hand. Minnie looked up at Dr. Holt with tears streaming down her cheeks.

"Thank you for helping us, Dr. Holt," she choked, "We would never have gotten this chance without you."

Lianne tapped out her own message. Michael listened to the letters, emotion constricting his own throat.

_"T-H-A-N-K Y-O-U D-O-C-T-O-R."_

There was a pause, then a long, extended beep as every monitor flat-lined. Michael escorted the family out of the room.

That evening, Karthey Devanne waited patiently as the nurses went over the pre-operation procedures, drawing vials of blood for testing, explaining exactly what they intended to do, what to expect when Karthey awoke, and the like.

Michael ensured that Mrs. Devanne had a comfortable place to sleep in Karthey's room.

"See you in the morning," he said.

The following morning, Michael greeted Rita and immediately proceeded to the scrub room. Karthey lay on the table while the anesthesiologist calmed her with his gentle banter on the early uses of nitrous oxide as a recreational drug. He slipped the mask over her face, and Karthey was unconscious after two deep breaths.

"Let's get to work," Michael announced to his team.

The surgery went even better than Michael could have asked for. The old shunt came out cleanly, and the new shunt slipped right into place. Michael saw Karthey off to the recovery room to wait until she regained consciousness, and walked out to the lobby.

Minnie Tanner was waiting for him. She held a small book in her hands.

"Dr. Holt," she said, "I wanted to show you this, to show you how much your help means to all of us." She opened the book and showed him the spidery Chinese characters mixed with English letters and simple words.

"It's Gramma Lianne's journal," Minnie said, "from when she lived in an internment camp in California. We would have thrown it away with the rest of her books if we had not known that she could tell us what it was." Minnie sniffed and wiped her eyes, "Reading this, it's like she is still here with us."

Michael laid a comforting hand on her shoulder, "Lianne probably wanted nothing more than to see her grandchildren getting along. I am sure she died exactly how she wanted to, among her loving family who loved her and loved each other. I don't doubt that she could have died earlier, but she was waiting for you all."

Minnie nodded.

"Michael?" Rita approached and took Minnie's hand. She looked at him, "Karthey's awake."

Michael nodded and left Minnie in Rita's capable hands.

Karthey was indeed awake by the time he arrived in her room. She was still a bit woozy from the morphine, but she looked plenty healthy.

"How do you feel?" he asked her.

Karthey smiled, "It's great to be alive," she admitted.

The three of them chuckled.

"Thank you, Dr. Holt," Karthey told him. "I owe you my life."

Michael shrugged, "I'm just glad everything worked out okay. We got the old shunt out, too."

"You did? That's great!"

"We'll see you later, Karthey."

"All right."

Michael left the room resolving to pay more attention to patients in the future.


End file.
